Request Assistance – Sandy Springs Police Benevolent Fund

The Sandy Springs Police Benevolent Fund (SSPBF) exists to provide limited financial assistance to members of the Sandy Springs Police Department, qualifying SSPD volunteers, First Responders and their families who are in need of support due to unforeseen circumstances or crisis. A qualifying crisis or unexpected need is determined by the Board.

Please complete the form below and explain the reason for the request and the amount of assistance requested. Please attach supporting documentation if appropriate.

APPLICATION FOR ASSISTANCE

All information is strictly private and confidential.

RECIPIENT INFORMATION
First Name:*
Last Name:*
Middle:
Address:
City:
State:
Zip:
Phone:*
Email:*
Recipient is:*
Check all that apply.
- Sandy Springs Police employee (Includes full time, part time & reserve employees)
- Sandy Springs Police employee family member
- Sandy Springs Police volunteer maintaining a minimum average of 4 volunteer hours per month
- First Responder servicing the City of Sandy Springs
- Immediate family member of First Responder servicing the City of Sandy Springs
- First Responder from other Public Safety agency
APPLICANT INFORMATION
Full Name:*
Employee ID # or Department:
Address:*
City, State, Zip:
Email Address:*
Phone Number:*
EXPLAINATION OF ASSISTANCE
Please explain the reason for the request and the amount of assistance requested.*
Please attach supporting documentation if appropriate.
Attach Supporting Documentation if Needed
Drop files here or

Accepted file types: doc, jpg, jpg, pdf, png, docx, Max. file size: 512 MB.
Electronic Signature*
I warrant the truthfulness of the information provided in this application. I understand that my electronic signature (above) constitutes a legal signature confirming that I acknowledge and agree to the Terms of Acceptance.

APPLICATION FOR ASSISTANCE

RECIPIENT INFORMATION

APPLICANT INFORMATION

EXPLAINATION OF ASSISTANCE